Healthcare Provider Details

I. General information

NPI: 1336692177
Provider Name (Legal Business Name): AN-THU VUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 ZANG ST 218
LAKEWOOD CO
80228-1066
US

IV. Provider business mailing address

403 ZANG ST #218
LAKEWOOD CO
80228-1066
US

V. Phone/Fax

Practice location:
  • Phone: 832-375-5016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSLP.0000127
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: